急诊创伤重点超声评估检查对腹部闭合性损伤患者诊断及休克预测价值  

The value of FAST examination of emergency in diagnosis and predicting shock for patients with abdominal closed trauma

作　　者：王志华 顾东明 盛乐智 徐主恩 林兆奋[2] WANG Zhi-hua;GU Dong-ming;SHENG Le-zhi(Department of Critical Care Medicine,Fudan University Fudong Medical Center,Shanghai 201399,China.)

机构地区：[1]复旦大学附属浦东医院重症医学科,上海201399 [2]上海长征医院急救科,上海200003

出　　处：《中国医学装备》2018年第12期89-92,共4页China Medical Equipment

基　　金：上海市浦东医院"浦菁计划"人才培养计划(PJ201501)"急诊超声在严重创伤患者休克预警及监测中的应用价值"

摘　　要：目的:探讨分析急诊床旁超声创伤重点超声评估(FAST)检查对腹部闭合性损伤患者诊断及休克预测价值。方法:选择医院收治的131例急诊腹部闭合性损伤患者,按照病情进行分组,将81例合并失血性休克的患者纳入休克组,将50例无失血性休克的患者纳入无休克组。两组患者均经床旁超声FAST及CT检查,床旁超声检查计算患者下腔静脉-塌陷指数(IVC-CI),对比分析两种检查结果的诊断符合率,并采用受试者工作(ROC)曲线分析床旁超声FAST检查IVC-CI指数对患者休克预测价值。结果:床旁超声FAST检查与CT检查对各类型腹部损伤患者诊断准确率比较均无显著差异,其诊断时间明显低于CT诊断时间,差异有统计学意义(t=40.504,P<0.05)。休克组患者床旁超声IVC-CI及休克指数显著高于无休克组,其差异有统计学意义(t=13.489,t=15.824;P<0.05)。采用ROC曲线分析床旁超声IVC-CI指数对休克预测价值,曲线下面积为0.960。床旁超声FAST检查IVC-CI指数与休克指数呈显著正相关关系(r=0.892,P<0.05)。结论:急诊床旁超声FAST检查腹部闭合性损伤诊断准确率与CT检查无差异,但检查时间更短,床旁超声IVC-CI指数对患者休克具有着良好的预测价值,并能够反映患者休克严重程度。Objective:To explore and analyze the value of focused assessment sonography trauma(FAST)examination of emergency in diagnosis and predicting shock for patients with abdominal closed trauma.Methods:131 patients with abdominal closed trauma in emergency were enrolled in this study and were divided into shock group which included 81 patients who combined with hemorrhagic shock and non-shock group which included 50 patients without hemorrhagic shock.Both two groups underwent FAST of bedside ultrasound and CT examination,and bedside ultrasound examination was used to count inferior vena cava collapse index(IVC-CI)of patients,and diagnostic coincidence rate of two examination results were further compared and analyzed.And receiver operator curve(ROC)was adopted to analyze the predicting value of IVC-CI of FAST of bedside ultrasound examination for shock of patient.Results:There was no significant difference in diagnostic accuracy for all types of abdominal injuries between FAST and CT,while the diagnostic time of FAST was significantly less than that of CT examination(t=40.504,P<0.05).And the IVC-CI of bedside ultrasound and shock index of shock group were significantly higher than those of nonshock group(t=13.489,t=15.824,P<0.05),respectively.ROC was adopted to analyze the predictive value of IVC-CI of bedside ultrasound for shock,and its area under curve was 0.960.Besides,there was a significant positive correlation between the IVC-CI of FAST of bedside ultrasound and the shock index(r=0.892,P<0.05).Conclusion:There was no difference in diagnostic accuracy rate between FAST examination of bedside ultrasound and CT examination for abdominal closed trauma in emergency,while the examination time of FAST was shorter.The IVC-CI of bedside ultrasound has a good predictive value for shock of patients and can reflect the severity of shock.

关 键 词：腹部创伤定点超声检查 腹部闭合性创伤 诊断 休克 

分 类 号：R445.1[医药卫生—影像医学与核医学]